Does rTMS Targeting Contralesional S1 Enhance Upper Limb Somatosensory Function in Chronic Stroke? A Proof-of-Principle Study.
Svetlana Pundik, Margaret Skelly, Jessica McCabe and 3 others
PMID 33514270WHAT IT FOUND
High-frequency brain stimulation to the side opposite the stroke, paired with sensory stimulation to the affected hand, made affected-arm two-point discrimination 1.187 mm better versus sham.
Other clinical sensory tests did not change.
Key findings
01The primary outcome, two-point discrimination on the affected arm, showed a significant session-type effect, and high-frequency rTMS improved it versus sham by an estimated mean difference of 1.187 mm.
02High-frequency rTMS also improved two-point discrimination on the unaffected arm versus sham by 0.710 mm and versus low-frequency rTMS by 0.663 mm.
03Proprioception, monofilament threshold, and vibration perception did not show significant differences between rTMS session types.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
Only 16 patients were enrolled in a single-session proof-of-principle design, so this cannot show that repeated treatment improves daily function. Every rTMS session was paired with peripheral electrical and vibratory stimulation, so the study cannot separate the effect of rTMS from the effect of peripheral stimulation. The study measured sensation and evoked potentials, not upper limb function, so it does not show that patients could use the hand better. The sample was younger than average for the stroke population, so results may not apply to older patients. Some measures were not sensitive enough to detect change, and proprioception baseline scores shifted across sessions.
Declared interests
No authors declared a conflict of interest. The article is marked as supported by N.I.H. extramural and U.S. government, non-P.H.S. research support.
The easy way to misread this
Do not conclude that rTMS alone improved sensation. Every rTMS session was paired with electrical and vibratory stimulation to the affected hand, and the study did not test either component alone. It was also a single-session proof-of-principle trial in 16 patients.